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If It Works for You, Then It Works

It's Time to Stop Talking About "Alternative" Therapies and Start Taking About "Complementary" or "Concurrent" Treatments -- Because Whatever Helps the Patient Is Helpful Therapy

August 1997

In this issue of AIDS Care we offer our readers two articles on the all-important subject of pain management. One of those articles was written for us by Dr. Howard Rosner, who directs the Pain Management Service at New York Hospital. As Dr. Rosner notes, "pain in patients with HIV disease is underdiagnosed and undertreated to an alarming degree," with less than 15% of these individuals getting adequate treatment for their pain.

This is a disturbing situation, but it is one that readers of AIDS Care can help to remedy, by following the advice Dr. Rosner offers in "Haven't Got Time for the Pain." This advice begins with the recommendation that people with HIV learn to let go of the notion that it is somehow wimpy or weak to complain about pain. It's not wimpy -- it's wise. After all, doctors and nurses cannot be expected to treat pain if they do not know it exists.

One type of pain that is particularly common in people with HIV is peripheral neuropathy, which can be a direct result of some disease process or an indirect result of taking certain antiretroviral drugs. In either case neuropathic pain responds well to a class of drugs known as tricyclic antidepressants. It also appears to respond to acupuncture, as contributing editor Kevin Armington points out in the second of our two articles on pain management, "Sticking It to Peripheral Neuropathy."

Acupuncture is commonly thought of as an "alternative" form of therapy, but in fact its history as a treatment for physical ailments predates the era of laboratory-produced drugs by several thousand years. In all that time, no one has been able to discover exactly how acupuncture works, when it does work. But then, no one knows why AZT is so effective in preventing mother-to-child transmission of HIV. It doesn't achieve its considerable effectiveness by reducing viral replication to undetectable levels, so how does it work?

We don't know the answer to that question. We don't know the answers to many such questions, but we do know that certain therapies -- including many so-called alternative therapies -- do seem to work, at least in some patients, some of the time. And many of these non-traditional therapies seem to work best when they are combined with standard drug therapy. For this reason, it is important for all of us, patients and care providers alike, to stop referring to any form of therapy as "alternative." This term suggests that therapy is a matter of either-or choices: You have to opt for drug therapy, or you have to choose non-traditional treatment, but you cannot have both.

This is a foolish -- and unnecessary -- distinction. Healthcare professionals need to think in terms of increasing the patient's choices, not reducing his or her options. And to do that we need to describe these choices in the same terms we use to describe combination antiretroviral regimens -- as being made up of elements that complement one another, that work concurrently to achieve an effect greater than any element can provide on its own, and that may even act synergistic ally when used in combination.

In short, we need to agree that if it works for the patient, then it works. Never argue with success.

Paul A. Volberding, M.D., is Editor-in-Chief of AIDS Care and AIDS Program Director at San Francisco General Hospital.

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This article was provided by San Francisco General Hospital. It is a part of the publication AIDS Care.
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